California Black Media

On October 8th, the House of Representatives passed the Affordable Health Care for America Act. On Christmas Eve. the Senate's The Patient Protection and Affordable Care Act passed 60-39 -despite the attempted Republican filibuster. With the two chambers of congress having each passed their own versions of a healthcare reform bill, all that's left is for President Obama to lend his signature to the measure, turning the healthcare bill into legislation.    

Before that happens, House and Senate must negotiate to reconcile the two bills into one.

While both versions anticipate increasing the number of insured legal residents under 65 years of age from 83%, the house would like to see that figure at 96% while the senate is reaching for 94%. Here are some other sticking points:

Individual Requirements: House: Individuals must have coverage with a 2.5% of income tax penalty for non-compliance. Financial hardship waivers would be available by application. Senate: Individual must have insurance either through an employer, government plan or privately. Those with financial hardship are exempt.  Penalties start at $95 in 2014 but increase to $750 over time.

Employer Requirements: House: Employers must provide coverage with penalty of 8% of payroll for non-compliance. Businesses with annual payrolls under $500,000 are exempt, while companies with 10 employees or less receive tax credits to assist in providing insurance. Senate: While employers are not required to provide insurance, businesses with workforces larger than 50 pay $750 per worker if those workers' coverage is subsidized by the government.

Illegal immigrants: House: Unable to receive government subsidies, but may purchase insurance from private companies. Senate: Unable to receive government subsidies or purchase insurance from private companies with their own money.

Government subsidies: House: Starting in 2013, would provide assistance according to a sliding scale to those with an annual income up to 400% of the federal poverty level ($88,000 for a family of four). Senate: To start in 2014, would provide tax credits for small business employers and those making up to 400% of the federal poverty level.

Choosing A Plan: House: A Health Insurance Exchange, to be operational by 2013, will be open to individual and employers. Senate: State-based purchasing pools would be available to small business and individuals who are uninsured or self-employed. Employees would be encouraged to continue with work-provided coverage.

Benefits: House: Suggests a cap on out-of-pocket expenses. “Essential benefits” package, including preventive services, would be recommended by a committee.  Senate: Plans would be required to cover basic benefits with four levels of insurance ranging from 60% coverage of yearly health care cost to 90%.

Government-Run Plan: House: Operated by the health and human services secretary, the public plan would be available through insurance exchanges. Senate: Doesn't offer a government-run health insurer. Instead, those in need of insurance could choose national plans managed by the same office that oversees coverage for Congress and federal employees.

Insurance Industry: House: Beginning 2013, there could be no denial of coverage nor higher premiums based on pre-existing coverage or gender with limits on age-based higher premiums. Senate: Same as House but to start in 2014 and include limits on high premiums based on family size, stipulated to lifetime limits on coverage, and - to start immediately - children up to age 26 can stay on parents in parent's insurance.

Medicaid: House: Medicaid would be extended to anyone under 65 and with incomes up to 150% of the poverty level ($33,075 for a family of four). Senate: Eligibility would be standardized to incomes up to 133% of the poverty level ($29,327 annually for a family of four)   

 Abortion: House: Private companies receiving federal subsidy money are not allowed to offer plans covering abortion nor may the government-run plan, with exceptions in cases of rape, incest or danger to the woman's life. Individuals could pay for separate supplemental abortion coverage. Senate: Beneficiaries would separately for coverage and states would be able pass legislation prohibiting certain plans from offering abortion coverage. Allows for same exceptions as House plans.

Cost over ten years: House: $894 billion to $1.2 trilion. Senate: $871 billion

Paying for it: House: Taxes on individuals making more than $500,000 a year and couples above $1 million will total $460 billion over the next ten years; $400 billion in cuts to Medicare and Medicaid; several billion gained in penalties from non-compliant individuals and employers; various corporate taxes and fees. Senate: Cuts to Medicare and Medicaid; 40% excise tax on insurance companies focusing on high cost premiums; increase of 2.35% to Medicare payroll on income over $200,000/individuals and $250,000/couples; 10% sales tax on tanning salons; fees on drug makers, medical device manufacturers, and employers with workers who pay premiums with government subsidies.